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Osteoarthritis

Slowing Joint Wear and Tear

Check out a chicken drumstick the next time you bake a bird. You'll note that the knobby end of the thighbone is covered with a tough, rubbery coating. That's cartilage, a tissue designed to cushion joints and ensure smooth motion.

In osteoarthritis, cartilage breaks down. It becomes frayed, thin, perhaps even completely worn away in areas. The underlying bone disintegrates, while painful bone spurs may grow around the edges of the joint. A formerly smooth, quiet joint may feel like it's grinding. It might even sound rough, like crinkling cellophane, when it's moved.

No one really knows why cartilage breaks down. Heavy use of a joint is sometimes a contributing factor. Also, a joint injured in the past tends to develop osteoarthritis sooner than a normal joint, perhaps because misalignment causes cartilage wear.

Osteoarthritis usually develops slowly, over many years. Some people never have more than a mild ache. Others develop crippling pain, and a few even end up trading in a creaky old hip or knee for a shiny new titanium-alloy model.

Many doctors who treat osteoarthritis consider it pretty much an unavoidable part of growing older. In fact, more than half of people ages 65 and older can expect to have at least a touch of osteoarthritis. Those same doctors think there's not a whole lot that can be done for this disease, except to nurse aching joints with mild painkillers such as acetaminophen or aspirin, heat and a careful balance of exercise and rest.

The relatively few doctors who treat osteoarthritis with nutritional therapy take a different stance, however. They contend that osteoarthritis is a metabolic disorder, a breakdown in the body's ability to regenerate bone and cartilage. Although they concede that the breakdown is partly the result of old age, they also believe that providing the proper nutrients, in proper amounts, can help stop the process of deterioration and reduce pain and swelling.

Unfortunately, while there is some sketchy evidence that certain nutrients can help osteoarthritis, the kind of large scientific studies that would confirm these benefits have yet to be done.

Until then, here's what doctors say may be helpful.

B₁₂ Gives Bones a Boost

Vitamin B₁₂ is best known for its role in maintaining a healthy blood supply. In the bone marrow, B₁₂ stimulates stem cells, a certain type of bone cell, to make red blood cells. When B₁₂ levels are low, people develop anemia.

But that's not the only role vitamin B₁₂ plays in bone. A few years ago researchers at the University of Southern California School of Medicine in Los Angeles discovered that B₁₂ also stimulates osteoblasts, another type of bone cell that generates not red blood cells but bone. That could be important to people with osteoarthritis, because underneath degenerating cartilage, bone also deteriorates, causing additional pain and further cartilage erosion.

This finding about vitamin B₁₂ led researchers at the University of Missouri in Columbia to try giving B₁₂ to people with osteoarthritis in their hands. They found that people who took 20 micrograms of B₁₂ (3.3 times the Daily Value of 6 micrograms) and 6,400 micrograms of folic acid, another B vitamin that works in concert with B₁₂, for two months had fewer tender joints and better hand strength and took less medicine for pain than people not getting this B vitamin combo. (This amount of folic acid is 16 times the Daily Value and should be taken only under medical supervision, as excess folic acid can actually mask signs of B₁₂ deficiency.)

"This doesn't necessarily prove that vitamin B₁₂ deficiency causes osteoarthritis or that getting extra B₁₂ will cure it, but I'd say it is definitely worth discussing with your doctor," says Margaret Flynn, R.D., Ph.D., a medical nutritionist at the University of Missouri-Columbia School of Medicine, the study's main researcher. She notes that the people in her study were not B₁₂-deficient. They were getting enough of the vitamin in their diets, and they had blood levels that are considered normal. Still, they benefited from getting more.

"Older people often have trouble absorbing vitamin B₁₂, and that accounts for about 95 percent of B₁₂ deficiencies in the United States," she says. Taking large doses of vitamin B₁₂ supplements may help overcome the absorption problem. Or your doctor may recommend B₁₂ injections, she says.

Vitamin E Eases Painful Joints

Joints damaged by osteoarthritis don't get as hot and swollen as joints hit with rheumatoid arthritis, but they are somewhat inflamed. That's one reason doctors sometimes recommend vitamin E for osteoarthritis. Vitamin E fights inflammation by neutralizing the biochemicals that are produced during inflammation. These biochemicals, released by immune cells, contain free radicals, unstable molecules that grab electrons from your body's healthy molecules, damaging cells in the process. Vitamin E offers up its own electrons, protecting cells from damage.

In a study by Israeli researchers, people with osteoarthritis who took 600 international units of vitamin E every day for ten days had significant reductions in pain compared with when they were not taking vitamin E. "Vitamin E also apparently stimulates the body's deposit of cartilage-building proteins called proteoglycans," says Joseph Pizzorno, Jr., N.D., a naturopathic physician and president of Bastyr University in Seattle.

Doctors recommend 400 to 600 international units of vitamin E, amounts that are considered safe, says Jonathan Wright, M.D., a doctor in Kent, Washington, who specializes in nutritional therapy and is the author of Dr. Wright's Guide to Healing with Nutrition. These large amounts are available only by supplementation. To get some vitamin E from foods, try sunflower oil, almond oil and wheat germ. Most people get about 10 international units a day.

Selenium, a mineral that increases the effectiveness of vitamin E, is often added to the osteoarthritis formula in amounts of about 200 micrograms a day. "That amount is considered safe, but you won't want to take much more than that without medical supervision," says Dr. Wright.

Vitamin C Stimulates Cartilage Repair

Most of us know vitamin C as an infection fighter and an immunity builder. But vitamin C is also used throughout the body to manufacture a variety of tissues, including collagen. Collagen forms a network of protein fibers that lay down the structural foundation for many tissues, including cartilage, bone, tendons and muscles, all necessary to keep joints strong and operating smoothly.

"It's well-known that animals deficient in vitamin C develop an array of health problems associated with collagen breakdown, including joint pain and cartilage breakdown," Dr. Pizzorno says.

Guinea pigs, one of few animals besides humans that can't make vitamin C in their bodies, show the classic symptoms of osteoarthritis--cartilage erosion and inflammation--when put on a diet containing only a small amount of vitamin C.

And one study suggests that large amounts of vitamin C encourage the growth of cartilage cells (chondrocytes) by stimulating synthesis of these cells' genetic material, report researchers at the State University of New York at Stony Brook.

"Although there are no human studies confirming a benefit, there's enough evidence out there, I think, to include vitamin C in a program to slow osteoarthritis," Dr. Pizzorno says. And there's some evidence that vitamins C and E work together to protect cartilage from breakdown. You can get sufficient vitamin C for this purpose in a multivitamin/mineral supplement, he says.

Niacinamide Could Be Worth a Try

You may not have heard of niacinamide. It's a form of niacin, one of the B-complex vitamins.

Some nutrition-oriented doctors have been recommending large doses of niacinamide for osteoarthritis since the 1940s, when William Kaufman, M.D., Ph.D., a pioneer in nutrition research for the treatment of osteoarthritis, found it helpful in relieving swelling and joint pain and improving muscle strength.

"I've treated more than 1,000 patients for joint dysfunction using niacinamide alone or combined with other vitamins," says Dr. Kaufman, now retired, of Winston-Salem, North Carolina. Improvement is usually noticeable after the first few weeks and becomes even more pronounced with continued treatment, he says. Very severely damaged arthritic joints respond slowly, or don't respond at all, to niacinamide treatment, however.

No one really knows why niacinamide seems to help osteoarthritis, Dr. Kaufman admits. "The vitamin is thought to somehow improve the metabolism of joint cartilage," he says. No further studies of niacinamide have been published since Dr. Kaufman's work, but reports of its clinical use remain positive.

"As a practitioner who has been doing this for more than 20 years, I can tell you that niacinamide is extremely effective in a large majority of cases at taking the pain out of osteoarthritis and in most cases at taking out the swelling, too, and apparently stopping the process," Dr. Wright says.

Niacinamide is often recommended as an alternative to niacin because it produces fewer side effects. This is one remedy, however, for which medical supervision is essential. The large amounts of niacinamide used in this treatment, from 500 milligrams twice a day to 1,000 milligrams three times a day, have the potential to cause liver problems.

"Anyone taking more than 1,500 milligrams of niacinamide a day should have a blood test for liver enzymes after three months of treatment, then annually thereafter," Dr. Wright says. "If the levels are elevated, the dose should be reduced." Nausea is an early warning sign of stress on the liver.

If you have liver disease, you should not use this treatment.

Adding a Bit of Insurance

Doctors who treat osteoarthritis make an additional recommendation that's designed to cover all bases. They recommend a multivitamin/mineral supplement that provides the Daily Values of all of the essential vitamins and minerals.

That recommendation might not be such a bad bit of advice. There's a scattering of evidence that a host of nutrients--pantothenic acid, vitamin B₆, zinc and copper and other trace minerals--play roles in maintaining healthy bones and cartilage. "And these nutrients interact in many ways that we still don't understand," Dr. Wright points out.